The Forum

The 2 key ways to improve patient flow during COVID-19

by Rebecca Richmond

Patient flow remains a hot topic for our members every year, but the new coronavirus pandemic has made this an even more vital area of focus.

Throughput management during the COVID-19 pandemic

Fortunately, Advisory Board has been researching patient flow for years, and in that time we've come up with several best practices to help hospitals and health systems improve efficiency and the patient's overall care experience. Below, I've outlined two key strategies hospital leaders can use to improve patient flow in both the short- and long-term.

1. Shift the default away from the ED

In recent research, we were keen to focus on relatively simple changes that can make a big difference—such as Pennine's approach to shift the 'default' of care from the ED to ambulatory care facilities.

There's more to it than what you see in this graphic (such as how to embed this new way of thinking and how to think about staffing plans for ambulatory units). But shifting from a long list of inclusion criteria (i.e. all these conditions can go to ambulatory care) to a much shorter exclusion list (everyone goes to ambulatory unless they meet these criteria) made a huge difference.

Pennine used posters, such as the one in the graphic below, to ensure this exclusion criteria was top-of-mind for staff at the front door of the hospital, online, in ambulances, and elsewhere.

More broadly speaking, we recently produced a whole study about ambulatory care strategy. I hope some of the thinking in that work might be useful to you, both short- and long-term, because in order to manage capacity and ensure we can deliver the right care in the right place at the right time, ambulatory care must become central—and that's never been more critical than it is right now.

2. Enable a frontline-design approach to surge protocols and pathways

We also spent a lot of time researching surge protocols and pathways. While quite a few organisations use predictive modelling to anticipate surges at front of house (albeit right now I suspect some of that predictive capability is kaput!), fewer organisations have developed pathways to enable frontline teams to adjust when the dashboard indicates a surge is coming.

At a time when we have to be agile and nimble, building protocols maybe doesn't seem like the right place to spend time. But consider convening a multi-disciplinary group of stakeholders representing every clinical and non-clinical team involved in delivering care to some of our most critical patient segments. I would argue they could pretty quickly build a list of the steps that must be taken to prevent the predicted surge from happening and, if nothing else, smooth out the patient journey where possible.

As leaders, it's time to focus on removing some of the barriers that have prevented this frontline-design approach from happening, such as time, team cultures, project management support, etc. And in terms of 'placing our bets' on which pathways we might focus on with the little time and resources we have, the 'Volume, Cost, and Risk' (VCR) approach we've seen from Germany to Brazil could help. Look at demand data through these three lenses—volume, cost, and risk—to select the top three to five pathways to revisit right now.

While cost and volume are standard analyses,  the risk factor, in terms of variable outcomes for patients and variable care decisions for staff, could transform how we think about this. And with COVID-19 heightening the necessity of knowing where those risks lie, I think some relatively speedy analysis using these three factors could be transformative.

As always, I'm very happy to talk to you and your teams more about this. Please do reach out—I'm always available via email.

 

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